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Objective: To determine the prevalence of university students who have ever engaged in self-harm and to examine its correlates. Frequency of thinking about self-harm was explored as a secondary outcome. Participants: Students at Western University in London, Ontario, Canada. Methods: This cross-sectional study was completed via an online questionnaire. Logistic regressions assessed the influence of sociodemographic and behavioral factors associated with lifetime self-harm and thoughts about self-harm. Results: The sample consisted of 2626 university students. Almost 25% engaged in self-harm in their lifetime and close to 33% have thought about harming themselves. A non-straight sexual orientation, marijuana use, prescription drugs not prescribed, and mental health problems increased the risk of both outcomes. Females were over two times more likely to engage in self-harm than males. Conclusion: This study provides evidence that is needed for developing effective interventions to reduce the risk of self-harm by targeting university students who are most at-risk.

The COVID-19 pandemic and associated public health measures have interrupted the daily routines of parents and children. The purpose of this study was to explore parents' attitudes regarding their children's play/sport during COVID-19. A secondary objective was to explore the influence of parent demographics and parent-reported physical activity levels and risk tolerance on these attitudes. Ontario parents of children aged 12 and younger completed an online survey (August-December 2020) that assessed their attitudes (grouped by support, safety and socialization-related attitudes; n = 14 items) regarding their child(ren)'s play/sport, their physical activity levels (n = 2 items), and demographic details (n = 16 items). Two open-ended items were used to gather a deeper understanding of attitudes. Parents' tolerance for risk was measured via the validated Tolerance of Risk in Play Scale. Descriptive statistics were calculated to describe attitudes and risk tolerance. Least Absolute Shrinkage and Selection Operator regressions were conducted to examine factors influencing parents' attitudes. Multiple linear models were computed using the identified predictors for each attitude category. Deductive content analysis was undertaken on open-ended responses. Participants (n = 819) reported the highest scores for safety-related attitude items (M = 3.54, SD = 0.63) followed by socialization and support, which all influenced attitudes regarding children's play/sport (p < 0.05). Demographics and parents' physical activity levels were identified as important predictors of parents' attitudes. Qualitative data revealed that parents had mixed levels of comfort with respect to their children's return to play/sport. Findings from this study reveal that increased support is needed to guide future play/sport decision-making.

Background: Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15-minute breaks and one 60-minute break) to a balanced school day (BSD) schedule (two 40-minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate-vigorous physical activity (MVPA). Methods: This study uses a case-control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10-12 years) were recruited from schools in Ontario, Canada. Results: Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in-school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence. Conclusion: Despite encouraging findings, more rigorous studies (ie, pre-post experiments with control) are needed to better understand how changing schedules impacts children's health.

Background: The COVID-19 a pandemic changed the world. Public health directives to socially distance with stay-at-home orders altered injury risk factor exposure, resulting injury patterns and conducting injury prevention (IP). The objective of this study was to determine the impact the COVID-19 pandemic on injury and IP at North American trauma centers (TC). Results: Sixty-two responses were received from pediatric (44%), adult (11%), and combined (31%) TC, from 22 American states, 5 Canadian provinces and Australia. The majority (91%) of programs targeted age groups from birth to 15 years old. Nearly one-third reported IP to be less of an institutional priority with funding redistributed in 15% of centers [median (IQR) − 25% (− 43, 1)], and resultant staffing changes at 38% of centers. A decrease in IP efforts was reported at 64% of TC. Overall, the majority of respondents reviewed injury data, with the top reported increased mechanisms mainly intentional: Firearm-related (75%), assaults (72%), and abuse (71%). Leading increased unintentional injuries were injuries occurring in the home such as falls (70%), followed by ATV (62%), and cycling (57%). Sites pivoted by presenting (74%) or participating (73%) in IP education virtually, social media posts (61%) and the addition of technology (29%). Top barriers were redeployment of partners (45%) and staff (31%), as well as lack of technology (40%) in the target population. Facilitators were technology at TC (74%), support of trauma program (63%), and having IP funding maintained (55%). Conclusions: Nearly two-thirds of TC decreased IP efforts during the pandemic due to staffing and funding reductions. The leading reported increased injuries were intentional, indicating that violence prevention is needed, along with support for mental health. While TC successfully pivoted by using technology, access issues in the target population was a barrier resulting in health inequities. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of university students who have ever engaged in self-harm and to examine its correlates. Frequency of thinking about self-harm was explored as a secondary outcome. Participants: Students at Western University in London, Ontario, Canada. Methods: This cross-sectional study was completed via an online questionnaire. Logistic regressions assessed the influence of sociodemographic and behavioral factors associated with lifetime self-harm and thoughts about self-harm. Results: The sample consisted of 2626 university students. Almost 25% engaged in self-harm in their lifetime and close to 33% have thought about harming themselves. A non-straight sexual orientation, marijuana use, prescription drugs not prescribed, and mental health problems increased the risk of both outcomes. Females were over two times more likely to engage in self-harm than males. Conclusion: This study provides evidence that is needed for developing effective interventions to reduce the risk of self-harm by targeting university students who are most at-risk. [ABSTRACT FROM AUTHOR]

Interventions to improve dietary quality and intake of fruits and vegetables (FV) among Canadian children have had modest success, and it has been suggested that food knowledge could be key to improvement. Programs have been criticized for insufficiently connecting food knowledge with food skills and decision making about dietary intake. The objective of this study was to investigate factors associated with FV consumption by elementary school children, aged 9–14 years, in Ontario, Canada, including food knowledge, socioeconomic status, sociodemographic characteristics, and the food environment. In 2017–2019, a cross-sectional survey was administered to 2443 students at 60 elementary schools across Southwestern Ontario (SWO), Canada. A parent survey was used to validate self-reported sociodemographic variables. The mean intake of FV reported by these participants was 2.6 (SD 1.1) and 2.4 (SD 1.2) servings/day, respectively. A FV intake below WHO guidelines was reported by 40.7% of respondents. Knowledge score, child age, and parent employment status significantly predicted higher reported intake of FV. This study shows that FV intake among this population group is low, and increased intake is associated with higher food knowledge. To encourage healthy eating, school-based food and nutrition programs that incorporate multiple components and emphasize food literacy are needed. [ABSTRACT FROM AUTHOR]

There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children's FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of 'frequently or always' consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported 'frequently or always' drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12–0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations. [ABSTRACT FROM AUTHOR]

Research provides evidence of take-home effects in school-based nutrition interventions, citing children as important influencers of family nutrition, acting as agents of change in the household and potentially influencing family food consumption. Therefore, the purpose of this randomized control trial was to examine whether implementation of a centrally procured school food program would produce changes in children's home food environment, including fruit and/or vegetable availability and parental modelling of fruit and/or vegetable consumption. A secondary objective was to investigate whether children's fruit and/or vegetable intake predicted their parent's fruit and/or vegetable intake. A total of 60 schools participated in the evaluation, including 2443 students (and their parents) in grades 5–8. Findings indicated that the intervention did not produce take-home effects on children's home availability of fruit (p = 0.52) and vegetables (p = 0.67) or parental modelling of fruit (p = 0.26) and vegetable consumption (p = 0.78), which may be related to the fact that only food provisions were given. However, children's fruit and vegetable consumption predicted parents' fruit and vegetable consumption (p < 0.001), thereby indicating that children may possess the capacity to influence home nutrition. Future school-based nutrition interventions are recommended to be multi-component (e.g. experiential learning, parent involvement) and that encourage nutrition leadership opportunities for children in the home context. [ABSTRACT FROM AUTHOR]

Background: Walkability is a popular term used to describe aspects of the built and social environment that have important population-level impacts on physical activity, energy balance, and health. Although the term is widely used by researchers, practitioners, and the general public, and multiple operational definitions and walkability measurement tools exist, there are is no agreed-upon conceptual definition of walkability.Method: To address this gap, researchers from Memorial University of Newfoundland hosted "The Future of Walkability Measures Workshop" in association with researchers from the Canadian Urban Environmental Health Research Consortium (CANUE) in November 2017. During the workshop, trainees, researchers, and practitioners worked together in small groups to iteratively develop and reach consensus about a conceptual definition and name for walkability. The objective of this paper was to discuss and propose a conceptual definition of walkability and related concepts.Results: In discussions during the workshop, it became clear that the term walkability leads to a narrow conception of the environmental features associated with health as it inherently focuses on walking. As a result, we suggest that the term Active Living Environments, as has been previously proposed in the literature, are more appropriate. We define Active Living Environments (ALEs) as the emergent natural, built, and social properties of neighbourhoods that promote physical activity and health and allow for equitable access to health-enhancing resources.Conclusions: We believe that this broader conceptualization allows for a more comprehensive understanding of how built, natural, and social environments can contribute to improved health for all members of the population. [ABSTRACT FROM AUTHOR]

Introduction: This study examines correlates of lifetime (ie, ever vaped) and past month vape use among students aged 17 to 19 years, 20 to 25 years, and 26+ years from Western University in London, Ontario. The secondary objective is to assess lifetime and past month vape use among students not of legal age to purchase vaping products in Ontario (ie, those 17 to 18 years only). Methods: Using Qualtrics, a cross-sectional survey was sent via email to all students at Western University (N = 38 442), assessing their current and past risk-taking behaviors, mental health, sociodemographic characteristics, as well as questions pertaining to their family structure and socioeconomic background during childhood. Students were asked if they had ever vaped in their lifetime and about past month vape use. Logistic regression models were used to assess correlates of lifetime and past month vape use. Results: The sample consisted of 2626 university students. Compared to those ages 26+ years, teenage university students were 10 times more likely to have vaped in the past month and males were twice as likely as females to have vaped. Alcohol use doubled the odds of vaping in the past month, whereas cigarette, cannabis, or cocaine use approximately tripled the odds. Students who reported many sexual partners were far more likely to have vaped in the past month. Conclusion: Vape use is more common among teenage university students, males, those who drink alcohol, smoke, use cannabis or cocaine, and who report many sexual partners. [ABSTRACT FROM AUTHOR]

An intervention, which used elements of the theory of planned behavior, was developed and tested in a randomized control trial (RCT) involving households in the city of London, Ontario, Canada. A bespoke methodology involving the direct collection and measurement of food waste within curbside garbage samples of control (n = 58) and treatment households (n = 54) was used to evaluate the effectiveness of the intervention. A comparison of garbage samples before and after the intervention revealed that total food waste in treatment households decreased by 31% after the intervention and the decrease was significantly greater (p =.02) than for control households. Similarly, avoidable food waste decreased by 30% in treatment households and was also significantly greater (p =.05) than for control households. Key determinants of treatment household avoidable food waste reduction included personal attitudes, perceived behavioral control, the number of people in a household, and the amount of garbage set out. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between knowledge and beverage consumption habits among children.Design: Cross-sectional analysis. Linear regression was used to identify sociodemographic, dietary and behavioural determinants of beverage consumption and knowledge, and to describe the relationships between children's knowledge and water and sugar-sweetened beverage (SSB) consumption.Settings: Seventeen elementary schools in London, Ontario, Canada.Participants: A total of 1049 children aged 8-14 years.Results: Knowledge scores were low overall. Children with higher knowledge scores consumed significantly fewer SSB (β = -0·33; 95 % CI -0·49, -0·18; P < 0·0001) and significantly more water (β = 0·34; 95 % CI 0·16, 0·52; P = 0·0002). More frequent refillable water bottle use, lower junk food consumption, lower fruit and vegetable consumption, female sex, higher parental education, two-parent households and not participating in a milk programme were associated with a higher water consumption. Male sex, higher junk food consumption, single-parent households, lower parental education, participating in a milk programme, less frequent refillable water bottle use and permission to leave school grounds at lunchtime were associated with a higher SSB consumption. Water was the most frequently consumed beverage; however, 79 % of respondents reported consuming an SSB at least once daily and 50 % reported consuming an SSB three or more times daily.Conclusions: Elementary-school children have relatively low nutrition and water knowledge and consume high proportions of SSB. Higher knowledge is associated with increased water consumption and reduced SSB consumption. Interventions to increase knowledge may be effective at improving children's beverage consumption habits. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Geographer is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess restaurant children's menus for content and nutritional quality; and to investigate the relationship between the restaurant consumer food environment for children and neighbourhood-level socio-economic characteristics within and between one Canadian city and one US city.Design: Cross-sectional observational study.Setting: London, ON, Canada and Rochester, NY, USA.ParticipantsRestaurant children's menus were assessed, scored and compared using the Children's Menu Assessment tool. We quantified neighbourhood accessibility to restaurants by calculating 800 m road-network buffers around the centroid of each city census block and created a new Neighbourhood Restaurant Quality Index for Children (NRQI-C) comprising the sum of restaurant menu scores divided by the total number of restaurants within each area. After weighting by population, we examined associations between NRQI-C and neighbourhood socio-economic characteristics using correlations and multiple regression analyses.Results: Nutritional quality of children's menus was greater, on average, in Rochester compared with London. Only one variable remained significant in the regression analyses for both cities: proportion of visible minorities had a positive effect on neighbourhood NRQI-C scores in London, whereas the reverse was true in Rochester.Conclusions: Results suggest the presence of a socio-economic disparity within Rochester, where children in more disadvantaged areas have poorer access to better nutritional quality restaurant choices. In London, results suggest an inverse relationship across the city where children in more disadvantaged areas have better access to better nutritional quality restaurant choices. Given these disparate results, research on restaurant nutritional quality for children requires additional consideration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15‐minute breaks and one 60‐minute break) to a balanced school day (BSD) schedule (two 40‐minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate‐vigorous physical activity (MVPA). METHODS: This study uses a case‐control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10‐12 years) were recruited from schools in Ontario, Canada. RESULTS: Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in‐school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence. CONCLUSION: Despite encouraging findings, more rigorous studies (ie, pre‐post experiments with control) are needed to better understand how changing schedules impacts children's health. [ABSTRACT FROM AUTHOR]

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. Methods: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action. [ABSTRACT FROM AUTHOR]

Background: Physical activity during childhood is associated with a multitude of physical, behavioural, and psychological health benefits. Identification of effective population level strategies for increasing children's physical activity levels is critical for improving the overall health of Canadians. The overall objective of this study is to assess how a naturally-occurring, community-level intervention which offers Grade 5 children in London, Canada a free access pass to physical activity opportunities (facilities and programs) for an entire school year can lead to increased physical activity among recipients.Methods/design: This study adopts a longitudinal cohort study design to assess the effectiveness of improving children's access to physical activity opportunities for increasing their physical activity levels. To meet our overall objective we have three aims: (1) to assess whether the provision of free access increases children's physical activity levels during and after the intervention compared to a control group; (2) to assess how and why child-specific trajectories of physical activity (between-children differences in level of physical activity measured across time) in the intervention group differ according to children's individual and household characteristics; and (3) to explore additional factors that are unaccounted for in the theoretical model to gain a further understanding of why the free access intervention had varying effects on changing physical activity levels. We will be addressing these aims using a mixed methods approach, including: a series of youth surveys conducted before, during, immediately after, and 4-months after the intervention; parent surveys before, during, and post-intervention; real-time tracking of the access pass use during the intervention; and focus groups at the conclusion of the intervention. Data compiled from the youth surveys will provide a subjective measure of physical activity to be used as our outcome measure to address our primary aims.Discussion: The results of this study can inform policy- and decision-makers about the sub-groups of the population that benefitted the most (or least) from the intervention to provide more specific information on how to develop and target future interventions to have a greater impact on the physical activity levels and overall health of children. [ABSTRACT FROM AUTHOR]

Although studies have looked at the effect of physical activity on obesity and other health outcomes, the causal nature of this relationship remains unclear. We fill this gap by investigating the impact of leisure-time physical activity (LTPA) and work-related physical activity (WRPA) on obesity and chronic conditions in Canadians aged 18-75 using instrumental variable and recursive bivariate probit approaches. Average local temperatures surrounding the respondents' interview month are used as a novel instrument to help identify the causal relationship between LTPA and health outcomes. We find that an active level of LTPA (i.e., walking ≥1 h/day) reduces the probability of obesity by five percentage points, which increases to 11 percentage points if also combined with some WRPA. WRPA exhibits a negative effect on the probability of obesity and chronic conditions. [ABSTRACT FROM AUTHOR]

This study examined environmental influences on a child's mode of travel between home and school. Grade 7 and 8 students (n = 614) from twenty-one schools throughout London, Ontario, participated in a school-based travel mode survey. Geographic information systems (GIS) were employed to examine environmental characteristics of the child's mode of travel between home and school measured at the scale of the likely travel route. Logistic regression was used to assess what factors influence both the to- and from-school trip. Over 62 percent of students living within 1.6 kilometers (1 mile) of school walked or biked to school and 72 percent walked or biked home from school. Actively commuting to school was positively associated with shorter trips, with distance being the most important correlate. Boys were significantly more likely to use active travel modes than girls. Higher traffic volume along the route was negatively related to rates of active travel and children from higher income neighborhoods were less likely to actively travel than children from lower income neighborhoods. In terms of environmental characteristics, the presence of street trees was positively associated and higher residential densities and mixed land uses were negatively associated with active travel to school. For the journey home, crossing major streets and increased intersection density were negatively associated with active travel. The findings of this research give evidence that active travel is associated with the environmental characteristics of walking routes. This information should be considered for urban planning and school planning purposes to improve children's walking environments. [ABSTRACT FROM PUBLISHER]

The economies of modern cities are dependent on an advanced retail system; so too are the people who inhabit them. The origin and evolution of retailing in London, Canada, was studied using a historical geographic information system (GIS) to document the relationship between a city and its retail sector. Visualization and spatial-statistical techniques afforded by the historical GIS were implemented to study change over time. The locations of retailers and the types of the goods they sold were examined for four periods in the city's early history: 1844,1863,1881, and 1916. The distances traveled to shop were also calculated for a variety of goods. The results indicate that the retail system was ingrained in the development of the city, showing marked locational patterns and a high degree of rationality in the shopkeepers' business strategies. Mapping the retail landscape in each era using historical GIS allowed for the examination of the relationship between retail and residential development in the growing city. While the downtown area remained the primary retail district for the city, considerable retail expansion also occurred at the urban periphery during this early stage of the city's development. [ABSTRACT FROM AUTHOR]

Montreal in 1881 was highly segregated along four distinct social dimensions: language, religion, socioeconomic status, and sector of employment. By 1901 the population had doubled, and we examine changes in residential distributions over the two decades. Despite the increased integration of certain groups, segregation remains high, and multiple dimensions are still discernible. In addition to long-established communities of French Canadians, Irish Catholics, and Anglo-Protestants, we see new streams of immigrants occupying their own patches in the urban fabric. To make meaningful observations of sociospatial changes over two decades, we used a geographic information system (GIS) to situate individual census households with spatial precision on 1 of 12,000 lots in 1881 and 30,000 in 1901, so that we could reaggregate them into meaningful districts of different scales and districts with identical boundaries for both years of observation, thereby overcoming the major methodological problems hindering previous comparative analyses. Coupling well-established statistical indexes of segregation and diversity in a GIS framework lends new analytic power to grasp the scale of phenomena and inquire into behavioral choices of nineteenth-century households. The empirical evidence shows how both concentration and diversity were built into the urban fabric. This study also offers methodological cues for comparative studies in other places and periods. [ABSTRACT FROM AUTHOR]

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This investigation sought to gain an understanding of how youth perceive neighborhood environmental influences on their physical activity and eating behaviors. This qualitative study targeted a heterogeneous sample of 12- to 14-year-olds in London, Ontario, Canada. Using a semi-structured interview guide, we conducted nine focus groups (n = 60) and used inductive content analysis to investigate their discussions. Most participants discussed their school, parks, and opportunity structures around their homes as influencing their physical activity, and overwhelmingly reported the availability of fast-food restaurants, convenience stores, and slow-food restaurants in their neighborhoods as influencing their eating practices. The descriptive information collected through this study is potentially significant for the efforts of city planners, policy makers, health professionals, school officials, and parents to promote and support healthier youth behaviors. [ABSTRACT FROM AUTHOR]

This paper examines the spatial distribution of recreational opportunities for children and youth in a mid-sized Canadian city (London, Ontario), in relation to the socioeconomic status of neighbourhoods and estimated local need for publicly provided recreation spaces. Public recreation facilities (N = 537) throughout the city were identified, mapped and analysed in a geographic information system. To explore potential socio-environmental inequities, neighbourhoods (N = 22) were characterized by socioeconomic and environmental variables, an index of neighbourhood social distress, a neighbourhood play space needs index, and measures of the prevalence and density of recreational opportunities. The results of the spatial analysis indicate there is no systematic socioenvironmental inequity with respect to the prevalence and density of publicly provided neighbourhood recreation spaces; however, there are several areas in the city where youth do not have access to formal play spaces. We argue that to promote physical activity among urban children and youth, city planners and health policy analysts should consider carefully the geographical distribution of existing recreational opportunities and ensure that new publicly funded recreation spaces are provided to neighbourhoods with the greatest need. Further research should seek to identify what kinds of recreation spaces are most effective for promoting healthy behaviours among vulnerable children and youth. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the association between fast-food restaurant density and adult body mass index (BMI) in Canada. Methods: Individual-level BMI and confounding variables were obtained from the 2007–2008 Canadian Community Health Survey master file. Locations of the fast-food and full-service chain restaurants and other non-chain restaurants were obtained from the 2008 Infogroup Canada business database. Food outlet density (fast-food, full-service and other) per 10,000 population was calculated for each Forward Sortation Area (FSA). Global (Moran's I) and local indicators of spatial autocorrelation of BMI were assessed. Ordinary least squares (OLS) and spatial auto-regressive error (SARE) methods were used to assess the association between local food environment and adult BMI in Canada. Results: Global and local spatial autocorrelation of BMI were found in our univariate analysis. We found that OLS and SARE estimates were very similar in our multivariate models. An additional fast-food restaurant per 10,000 people at the FSA-level is associated with a 0.022kg/m2 increase in BMI. On the other hand, other restaurant density is negatively related to BMI. Conclusions: Fast-food restaurant density is positively associated with BMI in Canada. Results suggest that restricting availability of fast-food in local neighborhoods may play a role in obesity prevention. [Copyright &y& Elsevier]

A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably. To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors. This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant. Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes. Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor. • Out of 25,263 live births, 5.7% were low birth weight and 7.5% were preterm birth. • Maternal exposure to sulfur dioxide was a top predictor of adverse birth outcomes. • Previous preterm birth was also highly associated with both birth outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate how retail food environments for children in the City of London and Middlesex County, Ontario, Canada, vary according to level of urbanicity and level of socioeconomic distress. Urbanicity in this study is defined as a neighbourhood's designation as urban, suburban, or rural. We assessed community food environments (e.g., the type, location, and accessibility of food outlets) using 800m and 1600m network buffers (school zones) around all public and private elementary schools, and we calculated and compared density of junk food opportunities (JFO) (e.g., fast food and full-service restaurants, grocery stores, and convenience stores) within each school zone in urban, suburban and rural settings. The study also assessed consumer food environments (e.g., the price, promotion, placement, and availability of healthy options and nutrition information) through restaurant children's menu audits using the Children's Menu Assessment tool. Results suggest JFO density is greater around elementary schools in areas with higher levels of socioeconomic distress and urbanicity, while urbanicity is also associated with greater use of branded marketing and inclusion of an unhealthy dessert on children's menus. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the uptake of ACT-i-Pass (G5AP), a physical activity (PA) intervention that provides free access to PA opportunities, and to understand the extent to which the intervention provides equitable access to children.Design: This study evaluates the differences in uptake (ie, enrollment) by comparing postal codes of registrants with the postal codes of all eligible children.Setting: Children were provided the opportunity to register for the G5AP during the 2014 to 2015 school year in London, Canada.Participants: The population of grade 5 students in London who registered for the G5AP (n = 1484) and did not register (n = 1589).Intervention: The G5AP offered grade 5 students free access to select PA facilities/programs during 2014 to 2015 school year.Measures: Measures included G5AP registration status, method of recruitment, distance between home and the nearest facility, and neighborhood socioeconomic status.Analysis: Getis-Ord Gi* and multilevel logistic regression were used to analyze these data.Results: There were significant differences in the uptake of the G5AP: residing in neighborhoods of high income (odds ratio [OR] = 1.062, P = .029) and high proportion of recent immigrants (OR = 1.036, P = .001) increased the likelihood of G5AP registration. Children who were recruited actively were significantly more likely to register for the G5AP (OR = 2.444, P < .001).Conclusion: To increase the uptake of a PA intervention, children need to be actively recruited. Interactive presentations provide children with increased access to information about both the program and its nuances that cannot be communicated as effectively through passive methods. [ABSTRACT FROM AUTHOR]

Exposure assessment in the context of mobility-oriented health research often is challenged by the type of spatial measurement technique used to estimate exposures to environmental features. The purpose of this study is to compare smartphone global positioning system (GPS), shortest network path mobility, and buffer-based approaches in estimating exposure to outdoor food and beverage advertising among a sample of 154 teenagers involved in the SmartAPPetite study during 2018 in London, Ontario, Canada. Participants were asked to report their home postal code, age, gender identity, ethnicity, and number of purchases they had made at a retail food outlet in the past month. During the same time period, a mobile phone application was used to log their mobility and specifically record when a participant was in close proximity to outdoor advertising. The results of negative binomial regression modelling reveal significant differences in estimates of advertising exposure, and the relationship to self-reported purchasing. Spatial exposure estimation methods showed differences across regression models, with the buffer and observed GPS approaches delivering the best fitting models, depending on the type of retail food outlet. There is a clear need for more robust research of spatial exposure measurement techniques in the context of mobility and food (information) environment research. • Exposure to outdoor food and beverage advertising has little association with purchasing among adolescents. • Comparison of GPS, network paths, and residential buffers in measuring exposure to outdoor food and beverage advertising. • Residential buffers and GPS delivered the best-fitting models, dependent on the type of retail food outlet under study. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic may have amplified the environmental, social, and economic implications of household food waste. A better understanding of household food wasting during the pandemic is needed to improve the management of waste and develop best practices for municipal waste management programs under crisis circumstances. A waste composition study was undertaken with 100 single-family households across the city of London, Ontario, Canada to determine the quantity and composition of household food waste disposed in June 2020, during the first wave of the COVID-19 pandemic. This study examines how household demographic, socioeconomic, and neighbourhood food environment characteristics influence household food wasting. On average, each household sent 2.81 kg of food waste to landfill per week, of which 52% was classified as avoidable food waste and 48% as unavoidable food waste. The quantity and composition of household food waste was found to be strongly influenced by the number of people and children in a household, and somewhat influenced by socioeconomic factors and neighbourhood food environment characteristics, including the availability, density, and proximity of retail food outlets. • This is one of the only direct measurement studies of food waste during COVID-19. • During COVID-19, sample households sent 2.81 kg of food waste to landfill per week. • 52% of household food waste was classified as avoidable and 48% as unavoidable. • Food waste was influenced by the number of people and children in a household. • Proximity to and density of some food outlet types influenced unavoidable food waste. [ABSTRACT FROM AUTHOR]

The article discusses the history of Chinatown in Victoria, British Columbia, focusing on the year 1891. It examines questions of racial segregation versus racial integration, suggesting that Chinatown was more heterogeneous than previously thought. The authors reflect on space, race relations, and British colonialism. They explore racism against Chinese immigrants and comment on Chinatown as a tourist destination. The authors' use of geographical information systems (GIS) and an 1891 census is considered.

Objectives: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited., Methods: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex., Results: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex., Conclusions: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada., Competing Interests: Declaration of conflicts of interest The authors have no conflict of interest to disclose., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types., Methods: We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years., Results: We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014-2020)., Conclusion: Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lena Palaniyappan reports personal fees for serving as chief editor from the Canadian Medical Association Journals, speaker/consultant fees from Janssen Canada and Otsuka Canada (2019), SPMM Course Limited, UK, Canadian Psychiatric Association; book royalties from Oxford University Press; investigator-initiated educational grants from Janssen Canada, Sunovion and Otsuka Canada outside the submitted work., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.

Introduction: Research has identified positive associations between green space and physical and mental health outcomes. Substance use outcomes, however, have received considerably less attention. This study investigates the association between residential greenness and substance use through an analysis of alcohol, tobacco, and marijuana use among youth and young adults., Methods: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS), as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multinomial logistic regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 youth and young adults (15-25 years)., Results: Residential greenness was not associated with alcohol use in general but was associated with lower odds of frequent binge drinking. Residential greenness was also associated with lower odds of tobacco use and greater odds of marijuana use., Conclusion: This study provides evidence that residential greenness is associated with patterns of substance use. The strength and direction of association, however, is highly contingent upon the substance under investigation. Living in greener neighborhoods may confer certain benefits to substance use and abuse among youth and young adults., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Research provides evidence of take-home effects in school-based nutrition interventions, citing children as important influencers of family nutrition, acting as agents of change in the household and potentially influencing family food consumption. Therefore, the purpose of this randomized control trial was to examine whether implementation of a centrally procured school food program would produce changes in children's home food environment, including fruit and/or vegetable availability and parental modelling of fruit and/or vegetable consumption. A secondary objective was to investigate whether children's fruit and/or vegetable intake predicted their parent's fruit and/or vegetable intake. A total of 60 schools participated in the evaluation, including 2443 students (and their parents) in grades 5-8. Findings indicated that the intervention did not produce take-home effects on children's home availability of fruit (p = 0.52) and vegetables (p = 0.67) or parental modelling of fruit (p = 0.26) and vegetable consumption (p = 0.78), which may be related to the fact that only food provisions were given. However, children's fruit and vegetable consumption predicted parents' fruit and vegetable consumption (p < 0.001), thereby indicating that children may possess the capacity to influence home nutrition. Future school-based nutrition interventions are recommended to be multi-component (e.g. experiential learning, parent involvement) and that encourage nutrition leadership opportunities for children in the home context., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

COVID-19 public health protocols have altered children's daily routines, limiting their physical activity opportunities. The purpose of this study was to examine how the COVID-19 pandemic affected children's (ages 10-12 years) physical activity and screen time, and to explore the impact of gender, socioeconomic status (SES), and public health constraints (i.e., facility use and social interaction) on the changes in children's health behaviors. Online surveys were disseminated to parents at two time points: before COVID-19 (May 2019 to February 2020) and during COVID-19 (November to December 2020). Wilcoxon signed-rank tests were used to assess changes in physical activity and screen time, and for subgroup analyses. Parents ( n = 95) reported declines in children's physical activity (Z = -2.53, p = 0.01, d = 0.18), and increases in weekday (Z = -4.61, p < 0.01, d = 0.33) and weekend screen time (Z = -3.79, p < 0.01, d = 0.27). Significant changes in physical activity and screen time behaviors were identified between gender, SES, and facility use groups. All social interaction groups underwent significant changes in screen time. Overall, COVID-19 protocols have negatively influenced children's physical activity and screen time. Due to the negative consequences of inactivity and excessive screen time, resources must be made available to support families during the pandemic.

Background: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions., Methods: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: "What feelings and emotions have you experienced around the pandemic?" and "What coping strategies have you used during the pandemic?" We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively., Results: A total of 1164 open-ended responses from Canadian adolescents ( n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities., Interpretation: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress., Competing Interests: Competing interests: Kendra Nelson Ferguson and Gina Martin received postdoctoral trainee support from the Children’s Health Foundation through the Children’s Health Research Institute. No other competing interests were declared., (© 2021 CMA Joule Inc. or its licensors.)

Food literacy is a set of skills and knowledge that are integral to diet. It is common among teenagers to not have basic food literacy skills needed to consume a healthy diet. This study examined: (1) the current state of food and nutrition knowledge among adolescents 13-19 years of age in the census metropolitan area of London, ON, Canada; and (2) correlates of food knowledge and nutrition knowledge among adolescents. Data for this study were drawn from baseline youth and parent survey data collected from a larger population health intervention study. Statistical analysis of the survey data indicates that higher parental education and higher median neighbourhood family income, the use of mobile health applications, liking to cook, as well as confidence in reading and understanding food labels were all consistently associated with increased food and nutrition knowledge. Findings may help guide future research towards optimal methods for delivering food literacy interventions to effectively educate teenagers. Results of this study may help guide policy makers, researchers, and public health professionals in developing appropriate food and nutrition programs and curriculums to combat the decline in food literacy skills.

Background: Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving., Methods: A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling., Results: The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001)., Conclusion: A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving., Level of Evidence: Therapeutic, level IV., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Dietary intake tools are used in epidemiological and interventional studies to estimate nutritional intake. The past-month Canadian Diet History Questionnaire II (CDHQII) has not yet been validated. This study aimed to assess the validity of the CDHQII in adults by comparing dietary results from the CDHQII to the same participants' 24-h recalls consisting of two weekdays and one weekend day. The recalls were collected using the validated multiple-pass method. Participants were asked to complete both tools at baseline, and again at 3-month follow-up. The study further aimed to determine which dietary intake tool was preferred by study participants by comparing completion rates. Data collection occurred at baseline (pre-intervention) and 3-month follow-up (post-intervention). Paired sample t -tests were conducted to compare means for the following nutrients (grams and %kcal): calories, protein, carbohydrates, total fat, saturated fat, unsaturated fat and sodium. Intraclass correlation coefficients of agreement and coefficients of variation were further calculated. Chi-square tests were used to determine the dietary assessment method with the greatest participant completion rate. At baseline ( n = 104), there were no significant differences between the results of the CDHQII and three 24-h recalls (averaged), with overall moderate correlation coefficients. At 3-months ( n = 53), there were significant differences ( p < 0.05) between dietary intake collection methods for all nutrients assessed in this study, except for saturated fat (%kcal), unsaturated fat (%kcal), protein (%kcal) and sodium (mg). Correlation coefficients were moderate. A significantly greater proportion of participants completed the three 24-h recalls compared to the CDHQII after 3 months (completion rates of 67.2% vs. 50.8% of the sample, respectively). The CDHQII provided estimates of mean nutritional intake (calories, macronutrients and sodium) that were comparable to mean intake established from three 24-h recalls, at baseline and was validated in a sample of primarily middle-aged, college-educated, Caucasian female adults with overweight and obesity for mean baseline or cross-sectional measurement only but not for assessing individual/patient dietary intake in clinical practice (r = 0.30-0.68). This tool was not validated at 3-month follow-up. Additionally, participants preferred the three 24-h recalls to the online, past-month CDHQII.

Objective: The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec)., Design and Setting: A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009., Primary Outcome Measure: Preventable hospitalisations (ACSC)., Participants: The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years., Methods: Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation., Results: Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I =0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation., Conclusion: The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The quality of children's diets has declined over the past few decades, giving rise to a variety of health-related consequences. In response to this trend, school food programs have become an increasingly effective method to support nutrition and lifelong healthy eating habits. This systematic review synthesizes current academic literature pertaining to school nutrition programs in Canada to identify existing interventions and their impacts on children's nutritional knowledge, dietary behaviour, and food intake. The review was conducted through a search of the following databases: ERIC, Education Source, CINAHL, PubMed, SagePub, SCOPUS, EMBASE, and CBCA. Information extracted from the articles included the program objectives, intervention design and components, research evaluation, and primary outcomes. A total of 11 articles evaluating Canadian school nutrition programs were identified. The programs incorporated a variety of intervention components including policy, education, family and community involvement, and/or food provision. These multi-component interventions were positively associated with children's development of nutrition knowledge, dietary behaviour changes, and intake of healthy foods; however, barriers associated with intervention duration, intensity, and availability of resources may have influenced the extent to which these programs impacted children's diets and overall health.

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings., Methods: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action., Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities., Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action., Competing Interests: The authors declare that they have no conflicts of interest.

Physical inactivity among children is a significant public health concern. Active school travel (AST) methods, such as walking and wheeling to school, can be a valuable way to increase children's levels of daily physical activity. In Canada, Active and Safe Routes to School (ASRTS), a national health promotion initiative, has led the campaign for AST through its flagship school travel plan (STP) program. At present little is known about the on-the-ground implementation processes that impede or facilitate the success of STPs. Through a thematic analysis of 18 interviews with STP facilitators and 4 focus groups with the larger STP committees, our study evaluates the factors shaping the functioning of STP interventions at ten elementary schools participating in a regional ASRTS program in Southwestern Ontario. Our analysis yielded six themes that have implications for STP implementation and sustainability: 1) accounting for school context; 2) establishing committee capacity and leadership; 3) supporting STP action; 4) responsiveness to external and internal barriers; 5) engaging schools at the grassroots level; and 6) building future champions. We draw from Lewin's Field Theory and discuss the forces affecting STP committees to frame our findings in a way that can be discussed to support the building of efficient, effective, and viable AST intervention environments., (Copyright © 2018. Published by Elsevier Ltd.)

Background: A triple-dose abusive head trauma (AHT) prevention program (Period of PURPLE Crying) was implemented. The third dose consisted of an education media campaign. The study objectives were to describe the qualitative and spatial methods developed to target AHT prevention and to evaluate this campaign., Methods: A questionnaire on the level of importance of factors, rated on a 7-point Likert scale, was distributed to a panel of experts to determine the best advertising locations. Ranked factors were used to create weights for statistical modeling and mapping within a Geographic Information Systems to determine optimal ad locations. The media campaign was evaluated via a telephone survey of randomly selected households., Results: The survey found locations of new families, high population density, and high percentage of lone parents to be the most important factors for selecting billboard sites. Spatial analysis revealed six areas that ranked highest in our factors. Five billboards, four media posters, and six transit shelters were selected for our advertisements. A population-based telephone survey revealed that 23% of respondents knew the campaign. Nearly half (42%) heard the radio public service announcements, and 9% saw billboards., Conclusion: Extending primary prevention efforts to the public helps to create a cultural change in the way inconsolable crying, the trigger for AHT, is viewed. With the use of ranked factors and Geographic Information Systems, geographic locations with high visibility and specific risk factors for AHT were identified for targeting the campaign, facilitating the likelihood that our message was reaching the population in greatest need.

Although physical activity has been considered as an important modifiable risk factor for obesity, the empirical evidence on the relationship between physical activity and obesity is mixed. Observational studies in the public health literature fail to account for time-invariant unobserved heterogeneity and dynamics of weight, leading to biased estimation of the effect of physical activity on obesity. To overcome this limitation, we propose dynamic fixed-effects models to account for unobserved heterogeneity bias and the dynamics of obesity. We use nationally representative longitudinal data on the cohort of adults aged 18-50 years in 1994/95 from Canada's National Population Health Survey and followed them over 16 years. Obesity is measured by BMI (body mass index). After controlling for a wide range of socio-economic factors, the impact of four alternative measures of leisure-time physical activity (LTPA) and work-related physical activity (WRPA) are analyzed. The results show that each measure of LTPA exerts a negative effect on BMI and the effects are larger for females. Our key results show that participation in LTPA exceeding 1.5 kcal/kg per day (i.e., at least 30 min of walking) reduces BMI by about 0.11-0.14 points in males and 0.20 points in females relative to physically inactive counterparts. Compared to those who are inactive at workplace, being able to stand or walk at work is associated with a reduction in BMI in the range of 0.16-0.19 points in males and 0.24-0.28 points in females. Lifting loads at workplace is associated with a reduction in BMI by 0.2-0.3 points in males and 0.3-0.4 points in females relative to those who are reported sedentary. Policies aimed at promotion of LTPA combined with WRPA like walking or climbing stairs daily would help reduce adult obesity risks., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: Frequent fast-food consumption is a well-known risk factor for obesity. This study sought to determine whether the availability of fast-food restaurants has an influence on body mass index (BMI)., Methods: BMI and individual-level confounding variables were obtained from the 2007-08 Canadian Community Health Survey. Neighbourhood socio-demographic variables were acquired from the 2006 Canadian Census. The geographic locations of all restaurants in Canada were assembled from a validated business registry database. The density of fast-food, full-service and non-chain restaurants per 10,000 individuals was calculated for respondents' forward sortation area. Multivariable regression analyses were conducted to analyze the association between restaurant density and BMI., Results: Fast-food, full-service and non-chain restaurant density variables were statistically significantly associated with BMI. Fast-food density had a positive association whereas full-service and non-chain restaurant density had a negative association with BMI (additional 10 fast-food restaurants per capita corresponded to a weight increase of 1 kilogram; p&lt;0.001). These associations were primarily found in Canada's major urban jurisdictions., Conclusions: This research was the first to investigate the influence of fast-food and full-service restaurant density on BMI using individual-level data from a nationally representative Canadian survey. The finding of a positive association between fast-food restaurant density and BMI suggests that interventions aiming to restrict the availability of fast-food restaurants in local neighbourhoods may be a useful obesity prevention strategy.